Transesophageal Echocardiography for the Noncardiac Surgical Patient

Abstract

Transesophageal echocardiography (TEE) has been established as a very valuable asset for patient monitoring during cardiac surgery. The value of perioperative TEE for patients undergoing noncardiac surgery is less clear. This article reviews the technical aspects of TEE and comments on the potential benefit of using TEE as a monitoring modality apart from cardiac surgery. Based on patient's comorbidities and/or injury pattern, TEE is a fast and minimally invasive approach to obtain important hemodynamic information, especially useful in a hemodynamically unstable patient. However, certain requirements for the use of the technique are necessary, most important the development of sufficient echocardiographic skills by the anesthesiologists. Indications, skill requirements, and possible complications of the technique are reviewed.

Primeras recomendaciones clínicas latinoamericanas para ecocardiografía perioperatoria. ECOSIAC.

“…El objetivo de la utilización de la ETE es la monitorización directa y en tiempo real del corazón y sus grandes vasos para así realizar un diagnóstico precoz y guiar la terapia con drogas vasoactivas y fluidos siguiendo las imáge-nes y mediciones de volumen y función de cavidades cardíacas 10,13,66 . El impacto positivo y beneficios del uso de ETE en cirugía vascular, ortopedia, transplante hepático, trauma, neurocirugía y en general en pacientes de alto riesgo o inestables han sido documentado en numerosas publicaciones 9,10,13,14,34,41,54,65,66,68,72-77, [80][81][82][83][84][85][86][87][88] .…”

Transesophageal Monitoring in Anaesthesia: An Update

“…Rescue echocardiography not only provided a diagnosis but also changed pharmacological and fluid therapy as well as directed emergency secondary procedures such as pericardial drainage, percutaneous coronary intervention and pulmonary thrombectomy. TEE may also have a role in determining the cause of hemodynamic instability in trauma patients unresponsive to fluid resuscitation [22]. TEE helps to diagnose pre-existing cardiac problems and traumatic thoracic injury but the risk of TEE-related viscus rupture potentiated by high gastric volumes or associated traumatic oesophageal injury must be considered.…”

Intraoperative Transesophageal Echocardiography: Review and Evolution

“…In addition, patients are at risk of hemodynamic instability due to several causes, blood loss, obstructed inferior vena cava flow, increased workload, embolization, and reduced systemic vascular resistance. These circumstances can be assessed by TEE and make a difference in patient's outcome, creating an opportunity to identify early and prevent future complications [49]. Concerns about these conditions may refrain anesthesiologists from practice intraoperative TEE.…”

“…TEE can be an important tool for patients with significant comorbidities or if hemodynamic instability is anticipated or occurs intraoperatively [49].…”